Tapetal sheen associated with the carrier state of X-linked retinitis pigmentosa

Female carriers of X-linked recessive eye diseases may show variable expression of the disorders depending on the timing of X-inactivation. Patients with late X-inactivation have widely dispersed affected cells intermixed with unaffected cells, sometimes producing a characteristic tapetal reflex or "metallic sheen" as seen in this photograph. This patient is an asymptomatic carrier of X-linked retinitis pigmentosa who has two affected sons.